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A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized

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A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized DOI: 10.7860/JCDR/2015/15121.6724 Original Article A Retrospective Analysis of Direct Medical Cost and Cost of Drug Therapy in Hospitalized Pharmacology Section Patients at Private Hospital in Western India PRAKASH R SHELAT1, SHIVAPRASAD KALAKAPPA KUMBAR2 ABSTRACT than 45 year age group. They were divided into medical and Background: Pharmacoeconomics is analytical tool to know surgical patients according to their admission in medical or cost of hospitalization and its effect on health care system surgical ward. Mortality, Intensive Care Unit (ICU) admission, and society. In India, apart from the government health patients on ventilator were significantly (p<0.05) higher in services, private sector also play big role to provide health care medical patients. Direct medical cost, ward bed charge, ICU services. bed charge, ventilator charge and cost of drug therapy per patient were significantly (p<0.05) higher in medical patients Objective: To study the direct medical cost and cost of drug while operation theatre and procedural charge were significantly therapy in hospitalized patients at private hospital. (p<0.05) higher in surgical patients. Cost of fibrinolytics, Materials and Methods: A retrospective study was conducted anticoagulants, cardiovascular drugs were significantly (p<0.05) at private hospital in a metro city of Western India. Total 400 higher in medical patients. Cost of antimicrobials, proton pump patients’ billing records were selected randomly for a period inhibitors (PPIs), antiemetics, analgesics, were significantly from 01/01/2013 to 31/12/2014. Data were collected from (p<0.05) higher in surgical patients. medical record of hospital with permission of medical director Conclusion: Ward bed charge, ICU bed charge, ventilator of hospital. Patients’ demographic profile age, sex, diagnosis charge accounted more than one third cost of direct medical and various costs like ICU charge, ventilator charge, diagnostic cost in all the patients. Cost of drug therapy was one fourth of charge, etc. were noted in previously formed case record form. direct medical cost. Antimicrobials cost accounted 33% of cost Data were analysed by Z, x2 and unpaired t-test. of drug therapy. Result: Patients were divided into less than 45 years and more Keywords: Charge, Cost, Intensive care Unit (ICU), Ward INTRODUCTION randomly from patient registration number. Data like age, gender, Pharmacoeconomics is analytical tool to know cost of hospitalization admission in medical or surgical ward, outcome of patient, cost and its effect on health care system and society [1]. Cost of of hospitalization including investigation charge, doctor consulting hospitalization includes direct medical cost, indirect cost and charge, ICU charge etc. were recorded in preformed case record intangible cost. Cost of hospital bed charge, laboratory charge, form. Direct medical cost, total cost of drug therapy and cost of diagnostic charge, doctor consulting charge, etc. were included in group of drugs were calculated. Charges of hospitalization was direct medical cost [1]. converted from Indian to United States currency (`62.19 INR = 1$ USD) exchange rate as per on date on 02/04/2015 available from In India, apart from the government health services, private sector official Reserve Bank of India’s website. The data were analysed at also play big role to provide health care services. Government of India the end of study by Z, x2 and unpaired t-test. reported that the private sector delivers about 60% of all inpatient care [2]. In India, during hospitalization 80% patients have to pay out of their pocket for health care service due to lack of insurance RESULTS cover and more than 40% admitted patient had to borrow money Total 400 patients’ billing record were collected and studied. Patients or sell their assets [3]. were divided into medical and surgical patients according to their Information about cost of hospitalization is helpful for policy makers Demographic data Medical Patients Surgical Patients Total Patients to allocate better health facilities and services [4]. It is also helpful in n=237 (%) n=163 (%) n=400 (%) developing country for reimbursement of social security system [5]. Age> 45 years 174(73.41)# 99 (60.73)# 273(68.25)# There is lack of data about direct medical cost of hospitalization in Age ≤ 45 years 63(26.59) 64(39.27) 127(31.75) admitted patients at private hospital in Western India. Hence we Male 127(53.58)@ 108(66.25)@ 235(58.75)@ carried out this study to analyze direct medical cost of hospitalization Female 110(46.42) 55(33.75) 165(41.25) and cost of drug therapy in admitted patients at private hospital in a Mortality 84(35.44)* 41(25.77) 123(30.75)* metro city of Western India. Patients on ventilator 92(38.81)* 38(23.31) 130(32.5)* ICU admission 124(52.32)* 68(41.17) 192(48)* MATERIALS AND METHODS Duration of stay in 8.37±2.16** 6.41±2.23 7.57±2.03** hospital (days) The study was retrospective syudy conducted at one private Procedure (surgical/ 46(19.4) 98(60.12)& 144(36)& hospital in metro city of Western India. A study approval was diagnostic) taken from medical director of hospital after assurance to maintain [Table/Fig-1]: Analysis of demographic data of patients (n=400) confidentiality of patients and hospital. To know direct medical cost, *p <0.05 (z-test) significantly higher as compared to surgical patients **p <0.05 (t-test) significantly higher as compared to surgical patients investigator collected data of 400 admitted patients’ billing record &p<0.05 (z-test) significantly higher as compared to medical patients #p <0.05 (X2 test) significantly higher as compared to age≤ 45 years for a period of 01/01/2013 to 31/12/2014. Data was selected @p <0.05 (X2 test) significantly higher as compared to female Journal of Clinical and Diagnostic Research. 2015 Nov, Vol-9(11): FC09-FC12 9 Prakash R Shelat and Shivaprasad Kalakappa Kumbar, Direct Medcial Cost in Hospitalized Patients www.jcdr.net (p<0.05) higher in medical patients as compared to surgical patients [Table/Fig-1]. Out of 400 patients it was observed that 98 (60.12%) patients admitted for surgical procedures (for appendicitis, gall stone, peptic perforation etc), 88(37.13%) patients admitted for cardiovascular disorder (CHF, LVF, IHD) and 63 (26.58%) patients admitted for Central Nervous System (CNS) disorder, CV stroke [Table/Fig-2]. Analysis of direct medical cost of hospitalization Ward bed charge, ICU bed charge and ventilator charge per patient were significantly (p<0.05) higher in medical patients as compared to surgical patients while Operation Theatre (OT) charge and procedural charge were significantly (p<0.05) higher in surgical patients as compared to medical patients. Consultation charge per patient and total cost of drug therapy were significantly (p<0.05) higher in medical patients as compared to surgical patients. Direct medical cost of hospitalization was significantly (p<0.05) higher in medical patients as compared to surgical patients [Table/Fig-3]. Cost of drug therapy [Table/Fig-2]: Analysis of diagnosis of patients (n=400) The cost of drug therapy per patient was calculated. Cost of drug (CHF=Congestive Heart Failure, LVF- Left Ventricular Failure, IHD- Ischemic Heart Disease COPD- therapy per patient in above 45 years age was significantly (p<0.05) Chronic Obstructive Pulmonary Disease) higher as compared to below 45 years age. It was observed that Group Medical Patients % of Surgical Patients % of Total Patients % of (n=237) Mean±SD total (n=163) Mean±SD total (n=400) Mean±SD total Cost in Cost in cost Cost in Cost in cost Cost in Cost in cost Indian US dollar Indian US dollar Indian US dollar Rupee Rupee Rupee Ward bed cost `7534±1250*# $121±20 11.82 `5769±1756 $92±28 10.42 `6815±1465* $109±23 11.29 ICU bed cost `18291±11234*# $294±180 28.67 `7513±3540 $120±56 19.88 `15325±9825* $246±158 25.38 Ventilator cost `8278±4324*# $133±69 12.98 `3791±2236 $60±35 6.85 `6450±3762* $103±60 10.68 OT cost(per hour) `359±124 $5±2 0.56 `3776±2631** $60±42 6.82 `1710±1246** $27±20 2.90 Consultation cost `4123±2764*# $66±44 6.46 `3182±2486 $51±39 5.74 `3707±2216* $59±39 6.2 Lab Investigation cost `1208±984 $19±15 1.89 `1193±1046 $19±16 2.15 `1202±892 $19±14 1.99 Radiology cost `1434±892 $23±14 2.25 `1265±972 $20±15 2.29 `1328±1026 $21±16 2.26 Procedural cost `3006±2182 $48±38 4.71 `9500±6408**# $152±103 17.15 `5652±3876** $90±62 9.37 Drug cost `16206±3286*# $ 260±52 25.41 `13326±2486 $214±39 24.06 `15032±2402* $241±38 24.90 Others (food, nursing care etc) `3348±1258*# $53±20 5.25 `2564±1682 $41±27 4.63 `3029±1928* $48±31 5.01 Total direct medical cost `63789±14692*# $1025±236 100 `55383±16838 $890±270 100 `60363±15824* $970±254 100 [Table/Fig-3]: Analysis of direct medical cost of hospitalization per patient (n=400) (Cost expressed in `Indian Rupee converted in $ US dollar) * p <0.05 (t-test) significantly higher as compared to surgical patients ** p <0.05 (t-test) significantly higher as compared to medical patients # p <0.05 (t-test) significantly higher as compared to total patients Group Medical Surgical Total Patients cost of drug therapy per patient in survived cases and patients on Patients Patients (n=400) (n=237) (n=163) Mean±SD ventilator support were significantly (p<0.05) higher as compared Mean±SD Mean±SD expired cases and patients without ventilator support [Table/ Cost of therapy per patient `11831±2876*# `8872± 2098 `10625±2258* Fig-4].
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